Remote afterloading for intracavitary irradiation of cervix carcinoma.

The technique of remote afterloading for intracavitary radiotherapy was developed by Henschke et al 15 years ago, and since then the technique has received wide acceptance, both abroad and in the United States. Here at Howard University, it plays an integral part in the intracavitary portion of the treatment of cervix carcinoma. Most applications are done on an outpatient basis without anesthesia or sedation. This has become possible by dilating the cervical canal painlessly with thin laminaria rods. Spread of the lateral colpostats is accomplished by inflating a Foley balloon secured to the applicator with contrast medias, instead of using the customary gauze packing for increased rectal distance.A single cobalt-60 source of 1 mm diameter and 3 to 7 Curies is used, which can be moved during the treatment to simulate linear sources of different lengths and loading. Our present treatment policy calls for 4,000 rad given to the whole pelvis in 20 fractions of 200 rad three times per week plus eight fractions of 400 rad by the remote afterloading technique given one fraction per week concomtant with the external irradiation. Only 18 patients have been treated to date with minimal adverse tissue reactions. There is only an 18-month maximum follow-up, so survival figures are still pending but all patients so treated are currently living without recurrence.